Longitudinal study of intravenous versus subcutaneous immunoglobulin replacement therapy in hematological malignancy.

AIM: To present findings from a longitudinal study on infection risk, mortality, and patient perspective of intravenous immunoglobulin (IVIg) and subcutaneous immunoglobulin (SCIg) treatment for patients with hypogammaglobulinemia secondary to hematological malignancy or its treatment (abbreviated as SID). METHODS: Observational study period included final year of IVIg (13 patients) and of the first 3 years of SCIg (17 patients) with SID. Data were collected on clinical outcomes from medical records and patient perception via study specific questionnaire. RESULTS: The median age was 63 years (53-76 years), and for 82.4% of patients their hematological malignancy was in complete remission. The annual mean serum IgG trough levels remained stable over the 4 years and were 7.0 g/L (±2.77 g/L) with IVIg, and 8.0 g/L (±1.75 g/L), 8.7 g/L (±2.75 g/L), and 7.6 g/L (±2.89 g/L) (year 1, 2, and 3, respectively) with SCIg. While the annual infection rate was similar, the rate of hospitalization due to infection fluctuated, with 37%, 9%, 15%, and 32% in year 1, 2, 3, and 4 respectively. There were no systemic adverse events with IVIg or SCIg. Patients reported a strong preference for SCIg. One patient died due to progression of underlying disease and infection within the study period. CONCLUSION: SCIg was the preferred treatment mode over IVIg in our cohort, but both were well tolerated without any systemic adverse events in 4-year follow up. The dosage and serum IgG levels were stable throughout. However, the number of infections requiring hospitalization fluctuated. It is anticipated that these findings encourage more hospitals to offer SCIg for SID patients.

Cohort profile: The Forzani & MacPhail Colon Cancer Screening Centre biorepository, Calgary, Alberta.

PURPOSE: The Colon Cancer Screening Centre (CCSC) biorepository (Calgary, Canada) supports a wide range of research topics related to colorectal cancer (CRC) by collecting, and storing biospecimens (blood, urine, normal colon tissue) from consenting patient participants. Housing unique biospecimens along with detailed participant lifestyle and health history questionnaire data, the CCSC biorepository can support a variety of research related to CRC risk factors, biomarkers, genetic causes and more. PARTICIPANTS: Currently, 2292 average risk CRC patients have consented to participate in the CCSC cohort and have provided stored biospecimens. The collected samples and data provide important high-quality materials for research, discovery and evaluation related to CRC screening and carcinogenesis and is available for access by outside researchers. In addition to biological samples, the CCSC collects detailed patient information on their lifestyle, physical activity and dietary patterns through questionnaires at the time of their enrolment. FINDINGS TO DATE: The majority of participants (75%) are between 50 and 64 years of age. Women make up 46% (1055) of the cohort. Additional characteristics of the cohort included 44% reporting a body mass index of 25-30 kg/m2 (overweight), 53% having never smoked tobacco and 13% having a family member with CRC. FUTURE PLANS: The CCSC cohort plans to include the recruitment of high risk CRC cohorts. High-risk participants would comprise patients with a positive faecal immunochemical test and family history of CRC.

Acceptability and yield of birth-cohort screening for hepatitis C virus in a Canadian population being screened for colorectal cancer: a cross-sectional study.

BACKGROUND: Screening for hepatitis C virus (HCV) is recommended in patients born between 1945 and 1965 ("baby boomers") in the United States. Because these patients are often screened for colorectal cancer, dual screening for HCV may enhance case identification. Our objectives were to assess the acceptability and yield of screening for HCV among patients undergoing screening for colorectal cancer. METHODS: Patients referred for a colonoscopy to screen for colorectal cancer completed an anonymous survey regarding the acceptability of screening for HCV, risk factors and prior testing. The impacts of demographics and risk factors for HCV on willingness to be screened were determined using logistic regression, and the stored sera of 483 patients who had undergone screening for colorectal cancer between February 2011 and August 2012 were tested for HCV antibodies. RESULTS: Among 1012 survey respondents (median age 56 yr; 911 [90.0%] were baby boomers, 880 [87.0%] were white and 223 [22.0%] were born outside Canada), 123 patients (12.2%) reported prior testing for HCV. HCV was previously diagnosed in 9 of these patients (0.9%, representing 1.0% of the patients who were baby boomers): 5 (55.6% of those diagnosed) reported risk factors. Excluding patients diagnosed with HCV, 903 (90.0%) respondents indicated that they would consent to testing of blood or saliva for HCV. After adjusting for age, sex and status of immigration, patients who were white (odds ratio [OR] 3.38, 95% confidence interval [CI] 1.81-6.32) and patients with risk factors (> 1 v. 0: OR 3.67, 95% CI 1.12-12.02) had a greater acceptance of screening. Among 483 patients screened for colorectal cancer, 3 were anti-HCV positive (0.6%, 95% CI 0.1%-1.8%), representing 0.8% (95% CI 0.2%-2.4%) of the patients who were baby boomers. INTERPRETATION: Acceptance of screening for HCV is high among patients undergoing screening for colorectal cancer in the Calgary area. However, the low prevalence of HCV suggests that the cost-effectiveness of birth-cohort screening in this population warrants evaluation.